A granular cell tumour is a rare lesion of probable nerve sheath origin. It is typically benign but up to seven per cent may be malignant. Since its original description in the tongue in 1926, the tumour has been reported to occur at many other sites in the body. The authors report a case of a 49-year-old African woman with an oronaso-parapharyngeal granular cell neoplasm causing mild dysphagia. The location of this tumour, which has not been reported previously, posed a unique surgical challenge. An initial attempt to remove the lesion transorally was only partially successful because it was too tough and adherent for conventional surgical dissecting instruments. Complete resection, however, was achieved with a carbon dioxide laser via the same approach. This information may be helpful in the management of other similar cases in the future.

Diffuse idiopathic skeletal hyperostosis (DISH), or Forestier’s disease, is an ossifying condition frequently encountered in otolaryngology as it affects 12–28 per cent of the adult population. This form of hyperostosis can manifest clinically with dysphagia, food impaction, hoarseness, stridor, myelopathies and other neurological problems. Judicious management of severe dysphagia proves challenging. The failure of conservative care often leaves surgery as the only option. In this report an anterolateral transcervical surgical approach to the confluent osteophytes is discussed and the value of videofluoroscopic swallow highlighted

Caffeine is considered to be a dehydrating agent with detrimental effects on the quality of voice of persons ingesting it. This has led medical personnel dealing with voice disorders, especially in the case of professional voice users, to give advice against the use of caffeine. Yet this is an anecdotal truth as an extensive Medline literature search did not reveal any scientific evidence of caffeine being proven to have adverse effects on the vocal folds. We, therefore, initiated this pilot study to ascertain the connection between caffeine and voice quality on a laboratory basis. Two hundred and fifty mg of caffeine were provided to eight volunteers in tablet form, and blood levels along with laryngograph readings were recorded to document the changes produced. Analysing the irregularities of frequencies in a) free speech b) a reading passage and c) singing ‘Happy Birthday’, substantial changes were seen to authenticate the fact that caffeine does produce alterations in voice quality but these alterations have considerable intrasubject variability. A full study with wider parameters is to be performed on this subject as we consider it to be of importance in the management of voice disorders.

Dercum's disease (adiposis dolorosa) is a rare condition characterized by progressively painful fatty deposits, usually, in menopausal women with obesity, asthenia and mental phenomena. We report a case of a 48-year-old woman with recurrent neck swelling and pain in the neck and parotid region, and a review of management of this uncommon problem.

Although injuries to the vertebral arteries are relatively uncommon, there are several different methods used to gain access to these vessels, and to control any bleeding arising from them. We describe a case of torrential oropharyngeal bleeding following a stab wound to the neck in which rapid access to the vertebral artery was gained using a paramedian mandibulotomy; this approach has not previously been documented. The other approaches are discussed.

Prostatic metastases in the nose and paranasal sinsuses are rare. Seven cases have previously been reported in the world literature. We describe the clinical presentation of a patient with prostatic metastases and the use of prostate specific antigen in confirming the diagnosis. We also review the literature about metasases involving the nose and paranasal sinuses.

Isolated nasopharyngeal tuberculosis is a rare disease with very few cases having been reported in recent years. We report a case presenting in the United Kingdom with unilateral otalgia and otorrhoea.

Intranasal injury without external involvement is not common. To our knowledge this is the first reported case of such an injury, caused by an assailant's two fingers forced up the nostrils of our patient causing severe mucosal laceration and excessive bleeding.

The patient died two weeks later.

Despite the abundance of minor salivary glands within the larynx, pleomorphic adenomas are rarely found. It is therefore not surprising that there are few reports of malignant mixed tumours in this site. We describe a case of carcinoma arising in a pleomorphic adenoma of the epiglottis which, to our knowledge, has not been described previously.

The patient underwent a horizontal partial laryngectomy and functional neck dissection and is well one year post-operatively. We feel this represents a suitable approach to treatment for this rare tumour.